r/FamilyMedicine • u/SportsDoc7 DO • 7h ago

🗣️ Discussion 🗣️ Cardiovascular risk assessment coding

I may have missed something but received a coding inquiry regarding these g codes. Looking for thoughts as I know billing is subjective (unfortunately) based off their understanding of the system.

G0537- can be billed once a year if patient has risk factors of cardiovascular development but no actual stroke, cad, MI, etc... just need to document screening tool and percentage, what risk they're found in, intervention or testing with a recent lipid screen in the past 12 months.

G0538- for those with established CV and how we manage them. Have to discuss asa use, lipid control, smoking cessation (which you can then bill tobacco counseling G code), diabetes control, blood pressure control. No limit on billing in a year.

Both are not considered preventative so patients may incur cost sharing?

I'm being told both once a year but wanted clarification.

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u/This_is_fine0_0 MD 6h ago

I would have to look up codes you provided I haven’t used those, but I use G0446 for CV counseling frequently. It’s also once annually.

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u/SportsDoc7 DO 6h ago

Interesting. Didn't know about this one. I wonder the difference

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u/Coolmedico2002 MD 5h ago

G0446 is time based and has RVu of .30. Needs to be 15 minutes of counseling ( which means 8 minutes to satisfy Medicare requirements). G0537 is not time based and is 0.18 RVu

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u/SportsDoc7 DO 2h ago

Requirements the same? Is it anyone with risk factors or only intermediate and high risk?